游离桡侧副动脉穿支皮瓣移植修复手外伤后虎口挛缩  

Free perforator flap of radial collateral artery on reconstruction of first web contracture after hand injury

作　　者：伍翰笙 吴霄 徐健锟 蔡诚凤 罗燕 邓建林 WU Hansheng;WU Xiao;XU Jiankun;CAI Chengfeng;LUO Yan;DENG Jianlin(Department of Hand and Foot Surgery and Rehabilitation,Guangdong Work Injury Rehabilitation Hospital,Guangzhou 510440,China)

机构地区：[1]广东省工伤康复医院手足康复科,广州510440

出　　处：《中华显微外科杂志》2023年第3期273-277,共5页Chinese Journal of Microsurgery

基　　金：广东省医学科研基金(B2021141)。

摘　　要：目的总结游离桡侧副动脉穿支皮瓣移植修复手外伤后虎口挛缩的疗效。方法回顾性分析2019年11月至2022年6月广东省工伤康复医院手足康复科收治的手外伤后虎口挛缩患者的临床资料。共纳入患者10例,其中男8例,女2例,年龄27~51岁,中位年龄40.5岁;左手6例,右手4例。术前测量虎口宽度和虎口夹角,4例属于重度虎口挛缩,6例属于中度虎口挛缩。所有患者均接受虎口开大手术,虎口开大后遗留软组织缺损范围为5.5 cm×2.0 cm~10.5 cm×3.0 cm,采用游离桡侧副动脉穿支皮瓣修复虎口创面,皮瓣切取范围为6.0 cm×2.5 cm~11.0 cm×3.5 cm,均携带臂后侧皮神经;臂外侧供区创面直接闭合。术后通过定期门诊及微信留取患者相关图像资料进行随访,观察患者移植皮瓣的颜色、质地、变化过程、供受区创面恢复及并发症发生情况。结果术后10例皮瓣均顺利成活,创面I期愈合;均获得随访,随访时间7~15个月,平均10.5个月。桡侧副动脉穿支皮瓣无臃肿,质地柔软,色泽正常,无色素沉着;末次随访时,10例患者虎口夹角(47.14±1.68)°和虎口宽度(5.34±0.52)cm均较术前[分别为(35.43±3.60)°、(3.17±0.75)cm]减少,差异有统计学意义(P<0.01),6例皮瓣恢复保护性感觉,8例治疗效果优,2例良,臂外侧皮瓣供区均只遗留线形瘢痕,无桡神经损伤症状。结论游离桡侧副动脉穿支皮瓣具有安全、美观的特点,是修复手外伤后虎口挛缩的良好选择。Objective To summarise the effect of free perforator flap of radial collateral artery on reconstruction of first web contracture after hand injury.Methods Retrospective analysis was conducted based on the clinical data of patients with first web contracture after hand injury in the Department of Hand and Foot Surgery and Rehabilitation,Guangdong Work Injury Rehabilitation Hospital from November 2019 to June 2022.Ten patients,8 males and 2 females aged between 27 and 51 years old with an average of 40.5 years old were included.There were 6 left hands and 4 right hands.Width and the included angle of first web were measured before surgery.Four hands were classified as severe first web contracture,and the rest of 6 hands had moderate first web contracture.After release scars of the first web,the areas of wound were 5.5 cm×2.0 cm-10.5 cm×3.0 cm.The flaps sized were 6.0 cm×2.5 cm-11.0 cm×3.5 cm.All of flaps carried the posterior cutaneous nerve of forearm.Donor sites were closed directly.All patients were included in postoperative follow-up regularly through outpatient clinic or via WeChat reviews.The colour,texture,process in change of the transferred flaps,donor and recipient sites healing and complications were observed.Results All 10 flaps survived and the wound healed by first intention.The patients received 7 to 15 months(10.5 months in average)of postoperative follow-up.The flaps were not bulky,texture and colour were satisfactory and without pigmentation.Protective sensations restored in 6 patients.At the last follow-up,average included angle of the first webs was 47.14°±1.68°,in comparison with 35.43°±3.60°before surgery.The average width of first webs was 5.34 cm±0.52 cm,in comparison with 3.17 cm±0.75 cm before surgery,the differences were statistically significant(P<0.01).Eight hands were rated excellent,and 2 were good.There were only linear scars left at the donor sites,without sign of radial nerve injury.Conclusion The free perforator flap of radial collateral artery is a safe and effective

关 键 词：桡侧副动脉穿支皮瓣 手外伤 虎口挛缩 修复 

分 类 号：R658.2[医药卫生—外科学]